Comment by df3 | Hacker News Reader

Comment by df3 | Hacker News Reader

The study did not seem to separate the results of those who completed online CBT from the majority who did not.

An interesting excerpt: "Take-up of computerised CBT was low, despite regular calls to encourage participants to use the programmes. The median number of sessions completed was two out of eight for Beating the Blues and one out of six for MoodGYM. Only 18% of people who started Beating the Blues completed all modules and 16% for MoodGYM."

Online CBT definitely is not effective if patients don't complete it despite receiving phone calls. I can imagine that getting the motivation to log in and do it is really difficult when you're already feeling hopeless-- even not-depressed people have enough trouble building and sticking to habits as it is.

But I still wonder if online CBT was effective for the small portion of participants who did complete it? What were the characteristics of those who did complete the app? Perhaps we can learn something.

CBT app builders should also consider that self-care options for depression have existed for a long time in the form of books. Can an app do a substantially better job than books? The idea of solving medical issues remotely has been tried for decades.

> despite regular calls to encourage participants to use the programmes

People aren't going to use it if it sucks or isn't giving them value. I looked into Beating the Blues a while ago - it's not exactly a great experience. Being reminded just isn't enough.

> Can an app do a substantially better job than books?

I think so.

Books are passive content that you consume in your own time. And, it certainly is helpful. But an app can do so much more towards offering a much richer, more engaging experience. But - and this is crucial - you have to get it right. And I think it is MUCH easier to get a book right, than an app. A book is just the content - an app is a manifestation of that content; if the book could talk, what would it say? ask? how would it do it and how often?

We'll see. My side project is to scratch some CBT & behavioral itches I have had with an app. I could be entirely wrong, but I wont know till I finish and see if it is of use for me.

I think a large part of that is due to the fact that CBT therapy can feel patronising to a lot of people.

Hey, any chance you'd be open to telling me a bit about what you're working on? I'm on a bit of a... journey to get beyond the 'shitty contract webdev work', and the direction I'm looking to go is technology applied to psychology (therapy and/or lifestyle, in particular). My first thought was also some CBT-related app.

Sure. Well, It's an app to help you be a better person of your own design. CBT is one of the libraries to choose from, but there are others for leadership, relationships, health and so forth.

Hrm, I would not identify it as an appification of CBT - You can use it to help implement CBT or other behavioral/cognitive changes, but the actual understanding would need to be done previously, to get the most benefit. Although I suppose even without any previous knowledge or awareness, some value could be derived.

Completion dates are low much like for reasons that completion dates for MOOCs are low.

I have a scheduled time and place for meeting a doctor. Not going will inconvenience many people, so there's a lot of social pressure to go. I've already put it in my calendar, so mentally I've accepted that I'll be doing this for a couple hours. When I go, the next meeting will be scheduled, locking me into a virtuous cycle of commitment.

An online thing I can do on my own time? Ha! We've gotten pretty good at ignoring reminder emails, no set time was put into place, and there's no set rhythm.

The "right" way to test the effectiveness of the program is to still get people scheduled to go to a doctor's office, but instead of talking to a doctor, you use a computer (and schedule the next visit).

For people like me, the main advantage of college wasn't access to the professor's, it's the set timeframe, place, and penalties for not showing up. Same sort of thing applies here I think

> But I still wonder if online CBT was effective for the small portion of participants who did complete it?

MoodGym and Beating the Blues have some evidence behind them. NICE was recommending Beating the blues because they have some evidence of efficacy for it.

Maybe there's a simple fix. Something like Flo to keep people engaged with it, or some kind of gamifaction.

http://www.health.org.uk/flo

Or maybe Recovery College combined with online CBT?

http://www.health.org.uk/recovery-college

> NICE was recommending Beating the blues because they have some evidence of efficacy for it.

You know how 'traditional chinese medicine' came about? Mao needed to invent something to give to the peasants that wasn't expensive as real health care.

http://www.slate.com/articles/health_and_science/medical_exa...

You can read the evidence that NICE has.

Really off topic, and I'm probably being pedantic, but I don't see the conclusion that you've given from what's presented in the article, re: blaming Mao for the modern ideology that perpetuates chinese medicine. I mean, it's true that a dialectical approach would probably lead to the adoption of most ideologically useful form of medicine, but a distinct separation of 'chinese medicine' and 'western medicine' seems directly antithetical to what Mao was saying... the fact that Mao wanted to address rural/traditional medicine and integrate into a medical tradition doesn't imply that Mao is the reason for orientalism and mysticism with regard to that medicine, especially since those things obviously far predate Mao.

This is obviously refuted by the fact that Chinese ex-pats associated with the KMT in Taiwan (i.e. the very people who fled Mao) have been practicing "traditional Chinese Medicine" to varying degrees since their pre-Mao childhoods. To believe that Slate article is to believe that somehow Chinese herb shops appeared in Taiwan in response to propaganda from either Mao or the US Government and that these peoples' childhood memories were subsequently "revised". That makes absolutely no sense.

Edit: Perhaps what you mean is that the Western notion of Chinese medicine as a viable alternative to Western medicine was invented by Mao? That might have some shred of truth. But it's a very narrowly defined truth, and a very semantic one.

Revision of distant childhood memories is very common. We all trust our memories too much, especially in a legal context. Childhood memories are just as, if not more, malleable.

It's more useful to think of memories as Michael Bay's version of "Pearl harbor".

Yes. But it's one thing to question whether the chicken soup your mother made used canned or homemade stock. It's quite another to question whether she ever actually made chicken soup when you were sick, and then repeat that for the millions of other people who remember having chicken soup.

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